Emerging Mysterious Disease in the DRC Raises Alarm

Since the end of October, a mysterious illness has been raging in the Kwango province, in the Democratic Republic of Congo. To date, there have been more than 400 cases and several dozen deaths. The symptoms are similar to those of the flu, which suggests a respiratory illness. Experts from the World Health Organization (WHO) and the Africa Centers for Disease Control and Prevention continue to investigate. They report that some patients also suffer from malaria.

The Democratic Republic of Congo (DRC) is currently suffering from several epidemics. According to the WHO, it is the country most affected in the African Region by the mpox epidemic. It includes about 80% of laboratory-confirmed cases and deaths reported on the continent this year. Added to this is malaria, one of the main causes of morbidity and mortality in this country. The DRC is the second country in the world with the highest number of cases and deaths from malaria, behind Nigeria. Children under five and pregnant women are most affected.

Another disease has been causing concern in recent weeks, an illness that health authorities are struggling to identify. It appeared in the Panzi health district, a remote region in the southwest of the DRC, located about 700 kilometers from the capital, Kinshasa. Access is difficult – even more so with the current rainy season – and the communication network is limited, which does not facilitate the specialists' investigations. It takes approximately 48 hours to access it from Kinshasa by road.

Malnutrition identified as an aggravating factor

The main symptoms are similar to those of the flu. They include headache, cough, fever, runny nose, difficulty breathing, muscle pain and fatigue. During a briefing on December 5, Dieudonné Mwamba, director of the DRC's National Institute of Public Health, said these symptoms indicated a respiratory illness, reports the Guardian.

However, specialists still do not know its origin. Virus or bacteria? The causative pathogen remains to be determined. In a statement dated December 6, the WHO said that “a respiratory pathogen such as influenza or COVID-19 could be a possible cause, as well as malaria, measles and other diseases.”

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More than 400 cases and around 30 deaths have been reported in the Panzi health zone, according to the latest situation report. The majority of cases involve children, particularly those under the age of five. Please note that this rural and isolated region is particularly vulnerable: 40% of the population suffers from malnutrition, which constitutes an aggravating factor. Additionally, malaria is endemic in the region and can cause or contribute to severe cases. The DRC is also facing a smallpox epidemic and seasonal flu.

So far, this unidentified disease has been reported in seven of the 30 health districts in Kwango province. The cases are mainly concentrated in three of the seven districts concerned.

The DRC has a large population (more than 102.3 million people). It covers more than 2.3 million km² and shares borders with nine other countries. A new epidemic could thus quickly spread across the entire continent.

Tests hampered by difficult access and limited resources

Difficulties in access, as well as a lack of supplies and health personnel, delayed the diagnosis of the disease. Because this is really about identifying a disease and not a new disease, underlined the WHO in response to speculation about “disease X”. As a reminder, this term designates a previously unknown pathogen capable of triggering a serious global epidemic.

Laboratory tests are underway to determine the exact cause of the illness. The teams collect samples for laboratory testing and provide more detailed clinical characterization of detected cases. They are also studying transmission dynamics and actively searching for additional cases, both in health care settings and at the community level.

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Several different diseases may be involved in the current cluster of infections. Indeed, initial analyzes revealed that some patients who contracted the “mystery disease” also suffered from malaria. “ Of the 12 initial samples taken, 10 tested positive for malaria, but it is possible that more than one disease was involved “, declared a WHO spokesperson on December 10.

Scientists will collect and test other samples to glean as much information as possible. But on site, analysis capabilities are minimal. The samples must be sent to a regional laboratory in Kikwit, almost 500 km away, or to the national reference laboratory in Kinshasa, almost 700 km away. This is why diagnostic and response efforts take time. Not to mention that attacks by armed groups represent a direct risk for intervention teams in this country where insecurity reigns.

A “low” risk for the rest of the world at present

In summary, we currently do not know much about this disease, except that it can be concomitant with malaria. Several cases reported in family groups suggest potential transmission dynamics within households. Further investigations are necessary to confirm this point. The most severe cases concern malnourished people. Finally, most cases (64%) concern children under 14 years old.

“ The region suffers from high levels of malnutrition and low immunization coverage, leaving children vulnerable to a range of diseases, including malaria, pneumonia, measles and others said Tedros Adhanom Ghebreyesus, WHO Director-General.

Considering the current context of the affected area and the general presentation of symptoms, experts must exclude a number of suspicious diseases (measles, acute pneumonia, hemolytic uremic syndrome due to E.colietc.) through additional investigations and laboratory tests.

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The mortality rate and the number of cases are alarming, and probably below reality. Indeed, not all infected patients seek treatment and therefore escape detection. “ Clinics are rare, especially in remote areas, and often understaffed. In fact, the DRC has less than two doctors per 10,000 inhabitants. », Specifies Andrew Lee, professor of public health at the University of Sheffield.

WHO considers the overall level of risk to affected communities to be significant. At the national level, the risk is moderate – the epidemic is currently localized in the Panzi health district. Finally, at the regional and global levels, the risk remains low at present. However, authorities fear possible cross-border transmission to Angola, very close to the affected area. “ Continuous monitoring and cross-border coordination will be essential to mitigate this risk », They conclude.